Adapting Public-Private Partnership as Strategic Collaboration between Government and Philanthropy-Based Autism Spectrum Disorder Centre

Vol. No. 2022, Abstract The need for advance for the development of low-cost Autism Spectrum Disorder (ASD) centre projects which include all required programs by ASD populations is a crucial component of the growth equation between parents with typically developing (TD) children and parents with ASD children who are stressed due to financial issues. However, there is the budget limit for the Government to spend on these big investment projects despite the worldwide economic recovery is slowing down caused by COVID-19 pandemic and the increasing cost of living. These basic well-being needs should maintain the right direction growth like the demographic growth to satisfy the ASD population’s demand. Public-Private Partnership (PPP) has been an area of interest, as a new tool for supporting public service provision. PPP has been used worldwide in delivering public sector projects including Malaysia. Its implementation has proven to provide many benefits to the Government and the public as a whole. Therefore, the objective of this study is to enhance the partnership between the public and private sectors so that they can play an important role by collaborating with the Government to create partnerships in searching for enough sources. The conclusion of this study indicated that there are many established ASD centres used philanthropy funding worldwide including Malaysia. However, there is still the need to establish an ASD one-stop centre, to complete all ASD needs and requirements at a lower cost. This study contributes


Introduction
The global outbreak of the COVID-19 pandemic has infected more than 116 million people and resulted in the loss of more than 2 million lives as of this writing. Many businesses and organizations are experiencing various human resources issues during COVID-19 such as employee mental health and well-being, managing remote working, termination of employees, and a reduction of salaries and allowances. This is no exception of the child development centre for ASD that offers diagnosis, therapy and treatment for ASD children. They have had adverse effects since the movement control order (MCO) was announced on 18 March 2020. With Government restrictions in place and the shutdown of non-essential services, many businesses and organizations have shifted towards remote working and focused on finding collaboration tools. In accordance with the current situation worldwide, many businesses and organizations are now focused on accelerating its development through Public-Private Partnership (PPP) to increase collaboration between public and private sectors, thus the private sector feedback can serve the Government in agile policy-making.
PPP has been an area of interest, as a new tool for supporting public service provision. It is a mechanism of long-term cooperation agreements between Government and private sector for delivering affordable public services (Ismail & Harris, 2014). Besides, it is also known as a teamwork of both Government agencies and private sector with same interests, which are working together to improve the product's services, share risks, expenses and resources that are connected with infrastructure and services (Khaled, 2013). PPP has been used worldwide in delivering public sector projects including Malaysia. Its implementation has proven to provide many benefits to the Government and the public as a whole. Many areas of public policy used PPP for implementation such as public transportation, waste-disposal services, environmental development and wide range of social services (Jermsittiparsert et al., 2019).
Through implementation of PPP projects, Malaysia has experienced many successful projects that benefit the public, for example, KL Sentral, Light Rail Transit (LRT), medical facilities, highways, bus stations and others (Ismail, 2014). The benefits of PPP include achieving sustainable growth and equitable distribution for the community's improvement. Proposing an ASD centre will be a revolutionary initiative to provide a one-stop centre for ASD communities with the lowest cost in Malaysia. In the prospect of the ASD population in Malaysia, the inconsistency between this population demand and current public resources has become noticeable. Therefore, the objective of this study is to enhance the partnership between Government and ASD institutions as the private sector with the collaborations of philanthropic institution such as not-for-profit or religious institutions in searching for enough sources for ASD population.
Philanthropy consists of "private initiatives, for the public good, focusing on the quality of life". Philanthropy contrasts with business initiatives, which are private initiatives for private goods, focusing on material gain, and with Government endeavours, which are public initiatives for the public good, e.g., focusing on the provision of public services. A person who practices philanthropy is a philanthropist. Philanthropy is different from charity, though there is some overlap. The charity aims to relieve the pain of a particular social problem, whereas philanthropy attempts to address the root cause of the problem.
The Institute for Philanthropy is a not-for-profit organization that provides information and educational programmed to philanthropists and charitable organizations. Originally established in 2000 by Hilary Browne-Wilkinson, a former solicitor at University College London, the Institute currently operates from offices in London and New York. The Institute researches charitable organizations and charitable tax law and provides advice to potential donors on the efficient utilization of funding. The Institute works to increase effective philanthropy in the United Kingdom and internationally, by raising awareness and understanding of philanthropy, providing donor education, and building donor networks.
The conclusion of this study indicated that there are many established ASD centres used philanthropy funding worldwide including Malaysia. However, there is still the need to establish an ASD one-stop centre, to complete all ASD needs and requirements at a lower cost. This study recommended a PPP between Government and ASD institutions as the private sector with the collaborations of philanthropic institution such as not-for-profit or religious institutions. The partnership from multi sectors is important to achieve the social indicator goal in ensuring ultimate development for the Government and the public.

Literature Review Challenges Faced by Parents of Children with ASD
The term Autism Spectrum Disorder (ASD) is defined as a group of neurodevelopmental impairment conditions characterised by uncommon growth in the domains of social communication, social interaction, and adaptive behaviour as well as the existence of restricted and repetitive response pattern behaviour, communication, and socialisation (Etournaud, 2017) affecting up to 10/1,000 children worldwide. The incidence of ASD has increased in recent years. According to Baxter (2015), approximately 52 million cases of ASD have been reported worldwide. In 2014 statistics, approximately 47,000 Malaysians with autism, which is between the six months to the late 20s, and this number rises by three percent each year (Norhidayah et al., 2018). A smaller scale study revealed that ASD children in Malaysia are between the ages 18 to 26 months showed a rate of 1.6 in 1000 children, or approximately 1 in 625 individuals. According to recent statistics, there are 300,000 individuals living with ASD in Malaysia (Norhidayah et. al., 2018).
Malaysian Government recently put a lot of effort by introducing a lot of initiatives to help the parents to send their ASD children to the early intervention program and implementing various financial supports for them. Unfortunately, all those efforts seem not enough to help the parents of ASD children. The allowances are insufficient to finance the services for the treatment, therapy, medicine, and transportation for ASD children (Hisham, 2013). In a qualitative study conducted by Kartini, Jeanette, Kim, Miriam and Golden (2017), eight Malaysian mothers from different ethnic background (4 Chinese, 3 Malays and 1 Indian) shared their realization of the need for more support from the Government in terms of more special school for their children, therapeutic services, financial aid, and employment opportunities or a platform for ASD children talents. Furthermore, they also complained about the lack of therapy services and treatments for ASD children in Malaysia. Two of them described that there is a need for "one-stop centre," to save time and energy when getting multiple treatments. This is because the Government has therapies, but there is a long waiting list. In addition, the therapists were not really supportive and do not have enough experience for early intervention treatment (Kartini et. al., 2015). Subsequently, parents of ASD children financially burdened and lack of needed therapies gave parents no option but to search for the support of private therapists. This type of service offered at various children development centres incurred higher expenses. A study conducted by Lee, Odom and Loftin (2007) revealed that the cost of raising a child with ASD is three times higher than raising a TD child, meanwhile Zaki and Moawad (2016) reported that the cost for caring ASD children is more than twice of children without autism. Undeniably, the low-income level parents cannot afford the high expenses for therapy that would lead to more burden and instable financial condition. This is the main reason whereby the parents refuse to send their ASD children to the respective centre for the therapy or treatment. They need to search for extra income for the cost of a child's medical care (Zaki & Moawad, 2016). Indeed, parents should have high awareness of the importance of therapy or treatment so as to support the development of their ASD children.
According to Togneri (2014), parents should seek an alternative rather than sending their children to the general hospital, which is once a month therapy session, to other private children development centres that offer affordable and lower fees and more frequent sessions of therapy. A lot of the stress comes from the fact that all these things will lead to a heavy financial burden of raising an autistic child. Moreover, the ASD children require more special attention and specific equipment, and all these cost moneys. Below is a list of expenses parents with special needs child should expect: It is challenging and a lot of patients needed in order to take care of an autistic child. Some of the parents have more than one autistic child requires a lot of physical, mental and emotional strengths. As reported by Kartini et. al. (2015), mothers of ASD children are mentally, physically, and emotionally tired of going through the hardships experience of raising their ASD child. Household costs often include loss of employment and loss of income due to increased needs of the children in addition to large out of pocket expenses (Togneri, 2014). However, continuous and consistent effort from parents is important to ensure the ASD children can be well-trained since young to ensure they are capable of managing their daily routine independently as well as expressing their feelings effectively. Therefore, it is very important to ensure the Government and public awareness and sympathize about ASD care and well-being to support parents of ASD children emotionally and mentally. This is so as awareness and knowledge of these disorders are still poor among the public in general and the health and education community.

ITEM COST (RM) FREQUENCY
Hence, parents of ASD children should be assisted to ensure they can sustain their economic condition without having to resign from their current job. Frequent and consistent therapy can encourage the ASD children to progress well and easy for the therapist to follow up on the children's physical, mental and emotional development to prepare them for school or college. By doing so, it can improve the quality of life of ASD children and their families.

Public-Private Partnership (PPP) in Malaysia
The provision of public services and infrastructure is the major responsibility of the Government. However, lack of resources and continual increase in demand tend the Government to involve the private sector in the provision of public services by creating partnership called as a Public-Private Partnership (PPP) (Ahmad, Ibrahim & Bakar, 2018). The Malaysia Prime Minister's Department states PPP as a "form of cooperation between the public and private sector whereby a stand-alone business is created, funded and managed by the private sector as a package that encompasses construction management, maintenance, and repair work as well as replacement of public amenities comprising buildings, infrastructures, equipment and facilities" (PPP, 2009).
The Government of Malaysia uses a PPP as a tool for infrastructure development. There has been a time of renewed appreciation for the role of the state or Government after the failure and violations of privatization and the contracting out of services since the 1980s. Since then, a PPP was supported. In 1981, the Malaysia Incorporated Policy was introduced to promote cooperation between the public and private sectors, taking action and operating within a "Malaysian Company". Through this strategy, all sectors depend on each other where the private sector upholds business and sustainable growth, while the public sector establishes new strategies, defines the path and offers the necessary support services that are conducive to business success.
Subsequently, in line with the new approach adopted by the Government based on the new economic model in the 10th Malaysia Strategy, the Government aims to intensify its efforts to promote private sector investment in development projects. The Government has also set up a facilitation fund under the 10th Malaysia Plan to finance private industry infrastructure projects as the Government's contribution through public and private sector cooperation (PPP, 2009). PPP is believed to be desirable in Malaysia since it supports innovation in the implementation of projects in the private sector (Ismail & Harris, 2014). Therefore, in ensuring that PPP remains a feasible and effective procurement tool, the Government will continue to promote private-sector innovation by providing greater authority to privatesector firms to decide on the facility's design, funding option, and operation.
Malaysian Government has promoted the private sector's participation in the provision of public services using the idea of PPP, due to budgetary restraint, as a tool to speed up national development (Ahmad, Ibrahim & Bakar, 2018). Although Malaysian Government has been implementing PPP since the mid-1980s, however the distribution of funds from the 9th Malaysian Plan and enhanced plans of PPP projects in 10th Malaysian Plan were the penetration in PPP development in Malaysia (Ahmad et. al., 2018)  In Malaysia, the BLMT method is frequently practised and has been commonly adopted in the Malaysian health and education sectors for the past few years (Ahmad et. al., 2018).

Contract Management
Corporatisation was granted BLMT agreement in 2012 to build 5000-bed hostel for International Islamic University Malaysia (IIUM) in Pahang (Ahmad et al., 2018). This adoption in the health and education sectors makes the BLMT model accepted in developing the country. In this method, the Government pays rent to the private partner for the public services and constructed facility (Ahmad et. al., 2018 (Markom, & Rabiah, & Adawiah, 2012). Overall, there are 27 toll highways have been built using the BOT method. In addition, the development of the Government office buildings in Putrajaya, the federal Government administrative centre was done through the BLT method (Hamsa, 2014).
PPP has been implemented in Malaysia for more than 30 years and has contributed significantly towards the rapid growth of economic of Malaysia. Since 1983, Malaysia has successfully planned, assessed and executed more than 641 PPP projects involving total capital expenditure of RM182 billion (US$55 billion) (Hamsa, 2014). However, all the projects that will be implemented depends on the country specific needs whereby the Government has to do a better outreach to the private sector through market discussion to find out what kinds of PPP projects the private sector is interested in especially in the post COVID-19 era.

The Implementation of PPP in Malaysia
A project is called PPP project if it has the certain characteristics. The researchers adopt the characteristics of PPP by Ahmad et. al. (2018). First, a partnership consists of two or more players; one of them is public and the other is private. Second, each partner works as a principal and capable of negotiation. In Malaysia, the Governments set up a separate agency named UKAS that negotiates with private sector on behalf of the Government but does not enter into any contract. Third, for one-off transaction PPP is an incessant partnership which creates long-term relationships in certain parameters that are defined in PPP agreement. Fourth, in PPP arrangements, each partner contributes something in terms of resources such as capital or land or the creation of a partnership. Last, the most vital characteristic of PPP is sharing of responsibilities, risks and outcomes. PPP Unit in Prime Minister's Department had suggested the 'End to End' process of Request for Proposal (RFP) in a form of process flow as shown in Figure 2. The processes of the PPP in Malaysia begin with submitting project proposals from ministries or agencies, then reviewing the proposals to ensure that the submitted information is appropriate. If not, until the appropriateness of the information is assured, additional information must be presented. The process moves forward to review and analyse the project proposals based on the criteria set by the project management committee. In this phase, the feasibility is taken into account when sending the project proposals for decision making to PPP Unit, Prime Minister's Department. The approval of the project has to be done through the recommendation of the cabinet. If the proposal was approved by the cabinet, the value management lab process may be performed. The process continues with preparing, conducting, and evaluating the RFP documents, bidding exercise, and submissions. Therefore, in principle, the preferred bidder was recommended for approval by PPP unit and the cabinet. The successful bidder will be notified of the decision of the Government. Finally, the terms and conditions of the agreement were referred to the cabinet for signing an agreement, upon negotiation and final approval (PPP, 2009). There are a lot of challenges in implementing the PPP in Malaysia. Although Malaysia has experienced a lot of successful projects such as medical facilities, many highways, KL Sentral, Light Rail Transit (LRT), bus stations and others, there are also constraints that hinder the successful implementation of PPP projects through the possibility of project default, projects completed at a higher cost to the Government and the value for money is not realised (Ismail & Harris, 2014). In addition, according to Ismail and Harris (2014), the top five challenges or constraints that hinder the successful adoption of PPP in Malaysia are (1) lengthy delays in negotiation, (2) lack of Government guidelines and procedures on PPP, (3) higher charge to direct users, (4) lengthy delays because of political debate and (5) confusion over Government objectives and evaluation criteria. All those constraints mentioned will impede the benefits of using PPP. Subsequently, the lack of Government guidance on PPP procedures sends out a warning to the PPP regulatory body about the need to resolve the problem immediately. This is primarily because the introduction of PPP is still new and evolving in Malaysia, therefore, there is a need for specific guidance in the context of ASD children and practices on PPP is considered necessary by the industry's key players. Until now, there is a little guidance has been published on PPP implementation in Malaysia. However, the Government needs to state explicitly the goals of implementing PPP as a way of providing public services in Malaysia, as was previously done with the launch of the 1991 Malaysian Master Plan on Privatization, which sets out specific objectives, strategies, and policy implementation, thus highlighting the progress made and discussing the potential course of the program (Ismail & Harris, 2014).
Furthermore, the economic development also requires the public sector to improve PPP practice in Malaysia to ensure that the requirements of the public can be fulfilled at the best cost to the public sector as per the required standard. PPP ventures on highways, for example, currently allow the Malaysian Government to subsidize a portion of the toll charges (Ismail & Harris, 2014). The Government hence ought to create a win-win situation with the private sector without burdening the public as the end-user of the facilities given. In a study conducted by Rao and Safdar (2019), the researcher highlights several challenges which discourage the private sector to go for PPP. They perceived that PPP projects always get either held up or terminated due to large gaps in expectations between public and private sector, lack of clear objectives and commitment on the part of the Government, insufficient legal/regulatory frameworks, complexity in decision making, lack of proper risk management, difficulty to attract long-term finance from private sources at affordable rate, lack of credibility in Government policies, lack of transparency, shortage in domestic capital markets, and lack of competition.
Therefore, PPP implementation in Malaysia has proven to contribute many benefits to the Government and the public and is still continuously progressing, especially for the business organizations that were striving to recover from the impact of the global pandemic COVID-19. It is important for the parties involved in PPP to understand the characteristics of PPP and consider various challenges to overcome any constraints that will hinder the success of PPP. This is because PPP will continue to be one of the main instruments in implementing Government projects, specifically in globalisation and market liberalisation (Hamsa, 2014). Thus, the PPP will be successful through smart partnership between the private and public sector, in enhancing and transforming public service delivery for mutual benefits with a high level of commitment from the Government.
This shared prosperity concept between the proposed institutions may solve this large economic gap which indirectly increases social well-being (PPP, 2009). Social well-being is the extent to which you feel a sense of belonging and social inclusion; a connected person is a supported person in society. Social well-being is achieved when we have good relationships, social stability, and peace. A state of mental, physical, and social well-being has contributed to the strengthening of individuals, families, and communities. Well-being is utilized for both economic and social purposes. This concept had been introduced by the World Health Organization (WHO) in 1948. Throughout the years, the well-being concept has sustained its place as the main agendas for many Governments and policymakers around the world. In the meantime, individual well-being has recently been considered to become indicators of family well-being. As a matter of fact, family well-being has taken an interest in providing children's welfare, and recognition of the role in nurturing children's well-being (Wollny et al., 2010).
There are three PPP institutions in Malaysia that focusing on providing health services such as health care centre. These institutions are the International Islamic University Malaysia Teaching Hospital in Kuantan, Pahang and the Women and Children's Hospital as well as the integrated Health Research Institute Complex in Kuala Lumpur. Simultaneously, there are many social and financial support service established using philanthropy for autism well-being around world nowadays such as National Autism Society of Malaysia (NASOM) in Malaysia, UW Autism Center University of Washington, National Autism Society in United Kingdom, Scottish Autism FIFE one stop shops in Scotland and Alma Jordan Riddle Foundation. All these foundations established using endowment and philanthropy funding capital. In a webinar organized by APMG International titled "PPPs and COVID-19", the panel suggests the businesses the effective way to help those suffering from the impacts of COVID-19 (Baxter, Frilet, Korchakova-Heeb, Mourgues, Bana, & Dallas, 2020). There are a variety of PPPs that range of philanthropy to structured contractual agreements, philanthropic partnerships can offer engagements where companies (which have corporate social responsibility programs) can reach out to the public to facilitate with recovery from the pandemic impacts (Baxter et. al., 2020). Formal PPPs have a vast area for making impacts in health care and food security initiatives. This study adapts the United Nations ESCAP model (ESCAP, 2008;United Nations ESCAP, 2011). Figure 3 shows that the implementation of PPP project required commitment from many parties that includes financiers, Government, escrow agents, sponsor/stakeholders and customers. The partnership from multi sectors is important to achieve the social indicator goal in ensuring ultimate development for the Government and the public. The function of an escrow agent (person or entity) is to hold the property in trust for third parties while a transaction is finalized. Therefore, it is necessary to think from now on the most effective methods to re-strengthen the organization at the same time can continue to serve the community especially the children with ASD. This is a great opportunity for both public and private sectors to establish strong a collaboration of philanthropic institution as the main financier. This study recommended a PPP between Government and ASD institutions as the private sector with the collaborations of philanthropic institution such as not-for-profit or religious institutions (waqf, zakat and sadaqah) as the main financier. This study indicated that there are many established ASD centres used philanthropy funding worldwide including Malaysia. However, there is still the need to establish an ASD one-stop centre, to complete all ASD needs and requirements at a lower cost.